Notification of Changes for Business Entity
General Information
Business Entity Name:	DEJANOVIC VUCCO INSURANCE LLC
Incorporation / Formation Date:
FEIN:	812749558
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	TRUMBULL
Business Address
Address 1:	5143 MAHONING AVE NW
Address 2:
City:	WARREN
State:	OH
Zip:	44483
Phone:	330-847-7660
Fax:	330-847-0615
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	5143 MAHONING AVE NW
Address 2:
City:	WARREN
State:	OH
Zip:	44483
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	VUCCO DEJANOVIC INSURANCE SERV
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	JULIANA DEJANOVIC
Title:	VICE PRESIDENT/OWNER
Phone Number:	330-847-7660
Email Address:	BVUCCO@HOTMAIL.COM